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General NPI Number Information
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NPI Number | 1811852205
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Entity Type | Individual
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Provider Name | MRS. STACEY MARIE CALDWELL
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Gender | Female
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Dates
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Enumeration Date | 12/18/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 866 ESTELLA CT
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City | FLORENCE
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State | KY
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Zip | 41042-3115
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Country | US
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Telephone | 859-743-5522
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Fax |
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Provider Business Mailing Address
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Address Line | 866 ESTELLA CT
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City | FLORENCE
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State | KY
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Zip | 41042-3115
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 4048520
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License Number State | KY
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